Comparative assessment of hepatitis C virus-related arthritis and rheumatoid arthritis: Relation to clinical, serologic and ultrasonographic characteristics

Background

Extrahepatic manifestations of hepatitis C virus (HCV) infection includes HCV-related arthritis (HCV-A) that may mimic rheumatoid arthritis (RA). Musculoskeletal ultrasound (MSUS) can aid in discriminating both conditions.

Aim of the work

To study the clinical, serological and imaging (Xray, MSUS) characteristics of HCV-A and compare them to RA.

Patients and methods

The study included 30 patients with HCV-A and 30 age- and sex-matched RA patients negative for HCV. Ritchie articular index (RAI), tender joint count (TJC) and swollen joint count (SJC) assessed arthritis. Patient global health assessment (PGHA) and modified health assessment questionnaire (MHAQ) were evaluated. The erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), rheumatoid factor (RF), anti-cyclic citrullinated peptide (anti-CCP) and serum cryoglobulins were measured. Radiologic assessment included short Larsen score (SLS) and MSUS using 7-joint ultrasound score (US7).

Results

The mean age of the HCV-A patients was 45.8 ± 4.7 years; RA was 43.3 ± 5.6 years; F:M was 27:3 in HCV-A patients; 29:1 in RA; HCV-A patients had no subcutaneous nodules, joint deformities or bone erosions. US7 showed that Gray-Scale (GS)/Power Doppler (PD) synovitis and tenosynovitis had higher mean values in RA versus HCV-A patients (p < 0.001; p < 0.001; p = 0.011; p = 0.008 respectively). A significant correlation was found between SJC with GS and PD synovitis in both groups.

Conclusion

HCV-A differ from RA features as being non nodular, non-deforming, non-erosive and aid in the predilection of HCV-A diagnosis. MSUS can offer a useful imaging modality elucidating inflammatory components of HCV-A and highlighting the spectrum of the condition.